didgʷálič Immersion Training

Who Should Attend

Tribal health teams who would like to or are currently providing treatment for patients with opioid use disorder are invited to register for a two-day orientation and training with the didgʷálič immersion program.The training will be structured with the first half of each day being held at the Swinomish Casino and Lodge in Anacortes, Washington, followed by afternoons spent observing and interacting with the clinicians and staff at the didgʷálič Wellness Center.

Teams that will be considered are those who are in a position to champion change at their tribe and provide care to patients with opioid use disorder within the primary care, behavioral health, oral health or opioid treatment program setting. Team members might include: Leadership (e.g. tribal health directors, council members, and administrators), clinicians (prescribing MD/DO/NP/PA/DMD/DDS, nurses, social workers, pharmacists, nurse care managers, behavioral health specialists, etc) and quality improvement specialists.

Up to 10 teams will be selected to participate, with a maximum of 30 individual participants, based on interest level and geographic distribution throughout Indian Country.

After suffering a series of devastating losses in the tribal community due to opioid overdoses, the Swinomish Tribe designed and developed a unique treatment program called didgʷálič that integrates evidence-based substance use disorder treatment with holistic, culturally competent care to successfully deal with the effects of OUD. didgʷálič provides a full array of medications for opioid use disorder, primary medical care, dental care, mental health care, treatment of co-occurring disorders, and staff assistance to provide support with domestic violence, legal, housing, employment, parenting and other issues both causing and resulting from OUD. Didgʷálič also provides on-site child care and free transportation to eliminate barriers to treatment. The didgʷálič model embraces a team approach to care: each patient is treated by a medical provider, a certified substance use disorder professional counselor, nursing staff, a mental health counselor, as well as peer support specialists.

The didgʷálič model of care centers on and incorporates the tribe’s culture and values.The program promotes long-term, sustainable treatment rather than short-term fixes, allowing patients to stay in the community with their families during treatment. The program offers training for tribal members with a goal of building a new generation of clinically trained and culturally competent Native counselors and providers. The tribal government and individual tribal members also provide cultural leadership and advice on the use of Native language and practices in the program.

The didgʷálič model of treatment differs from the state-based Hub-and-Spoke models currently under development. The Hub-and-Spoke model relies on a system of referrals across and among providers within a robust existing inventory of providers. To deal with structural disaggregation of necessary OUD treatment components in the health care system, the Hub-and-Spoke model creates a network of coordinated and referred care. Patients may receive pharmacotherapy in one place, counseling in another, primary care in another, and the provider network is coordinated by navigators.

didgʷálič, in contrast, embraces fully integrated care, placing all components of effective OUD treatment under one roof. This model works well for Swinomish, because prior attempts at providing referred care resulted in very low rates of care delivery when patients were required to travel even short distances and overcome friction in the health care system to obtain the various components of OUD care. In this way, the didgʷálič model responds to the specific needs of Swinomish community members, and may offer tribes throughout Indian Country promising solutions that could be expanded upon.